Job Summary: Encodes, analyzes, and adjudicates routine medical, dental, vision, and prescription drug claims. Follows up on non-routine or incomplete claims. Meets strict performance standards set by employers and contracted providers. Works with other carriers to establish liability and level of coverage and coordinate benefits – primarily related to workers compensation, auto, insurance, and dual health coverage. Recommends changes or improvements to claims processing systems and information system interfaces. Provides telephone coverage to member and provider services on issues related to eligibility, coverage, and claims.
Education/Experience: High school diploma or equivalent with additional course work and one to two years health care claims experience, preferably with managed care. Good computer skills in Microsoft Office preferred; accuracy and speed of data entry; knowledge of third party liability, COB, and subrogation issues; medical terminology and ICD-9, CPT and UB92. Experience in Claims Processing or Managed Care; coding knowledge helpful.
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